One of the fastest growing areas in plastic surgery is the group of procedures designed to remove excess skin following massive weight loss. Due to the process of carbohydrate-restricted diets and, more importantly, the popularity of bariatric surgery, scores of patients are now interested in removing the excess skin they acquired while overweight. Our patients can undergo various procedures, including body lift, arm lift, and thigh lift, to remove extra skin after weight loss.
Bariatric surgery has advanced tremendously in recent years. The procedures are rapid, safe, and effective, with most patients losing over 100 pounds within the first year. It is estimated that over 175,000 morbidly obese patients underwent gastric bypass surgery in the United States during 2014.
While patients are justifiably ecstatic about their weight loss and their potential for leading a longer and healthier life, many are shocked by their appearance following their considerable weight loss.
Due to inadequate skin elasticity, massive weight loss often results in surpluses of skin, usually in areas most affected by weight gain: abdomen, breasts, inner thighs, and arms. Besides being unsightly, excess skin can interfere with clothing and activity while also leading to skin irritation and breakdown. Fortunately, there are plastic surgical procedures designed to remove this skin excess and recontour problem areas.
Timing of Plastic Surgery after Weight Loss
One of the most critical issues affecting the ultimate outcome of any plastic surgery is the timing. Results are clearly best when weight loss in the area operated on is virtually complete. Though patients who have experienced massive weight loss are understandably proud of their accomplishments - especially when they have lost over 100 pounds, they must face the reality that it is their residual weight that matters the most.
For instance, patients with thick abdominal tissue who still weight 200 pounds at the time of their abdominoplasty will never look as good as the patient with thinner abdominal tissue who weighs 175 pounds at the time of their surgery. Moreover, the risk of significant surgical complications will diminish as the patient approaches their goal weight. Though it may be emotionally hard, it is usually prudent to lose as much weight in the affected area before proceeding with plastic surgery.
Having said that, patients generally lose weight much faster in some areas than in others. Dr. Pin often sees patients, for instance, who have lost virtually all of their weight in their abdomen but still have a long way to go before addressing their inner thighs. In such cases, there is no reason not to perform abdominal rejuvenation first and delay the thigh procedure until a more appropriate time.
Plastic Surgical Procedures for Post-Bariatric Patients
Numerous surgical procedures exist to treat the consequences of massive weight loss. It is easier to think of these techniques in terms of the anatomical areas they address.
Following massive weight loss, some patients have a tremendous excess of lower abdominal skin called a pannus. In a relatively unsophisticated procedure, this excess skin is simply excised directly in an operation called a “panniculectomy”. This surgery is usually considered in patients with significant localized skin excess who really need to lose more weight before a more definitive operation should be done.
When a patient is closer to their goal weight, they become a candidate for a more complex surgery known as an “abdominoplasty,” where all the surplus skin from the umbilicus (belly button) to the pubic area is removed. This is commonly associated with tightening and repositioning the abdominal (rectus) muscles. With greater weight loss and skin excess, the surplus may extend around to the patient’s back. A “circumferential abdominoplasty” may then be chosen to provide the smoothest contour.
Finally, a more extensive form of a circumferential abdominoplasty called a “body lift” may be done for the additional purpose of lifting one’s thighs and buttocks. Obviously, the more extensive procedures with potentially the most dramatic results are associated with greater cost, risk, and recovery; therefore, each patient must be considered individually.
Despite weight loss, some patients still have large breasts and are candidates for breast reduction surgery where the primary goal is to reduce the patient’s breasts to more appropriately match the rest of their body. A secondary benefit of this operation is that it lifts the breasts as it reduces them.
Alternatively, many patients’ breasts look deflated after weight loss, with both volume loss and sagging. The sagging, or ptosis as plastic surgeons call it, can be treated with a breast lift or mastopexy. When a patient aIso wishes to restore breast size, a breast enlargement can be done at the same time, using either saline or silicone breast implants.
While clothing can be used to conceal most areas with excess skin, most of our Dallas skin tightening patients find it impossible to mask excess neck and facial skin following significant weight loss. The truth is many patients, despite feeling better after their weight loss actually look suddenly older. This apparent aging can be treated with standard facial rejuvenating procedures such as facelift and browlift.
Loss of upper arm fat can result in floppy skin from the axilla (armpit) to the elbow. As a result, women frequently avoid sleeveless garments, even in the heat or summer. A brachioplasty or arm lift can be used to reduce excess skin and residual fat. While new techniques help diminish and camouflage scarring, unsatisfactory scars are not uncommon with these procedures.
As with arms, excess skin in the inner thigh is unsightly and often interferes with clothing choices. When the excess is only vertical, a thigh lift can be done and the scar will lie in the crease. However, frequently after massive weight loss, the excess skin is circumferential extending toward the knee, and therefore the excision must also extend down the inner thigh.
All of these operations take a lot of time to perform properly and therefore few plastic surgeons would endorse treating all areas in one session. Commonly, two or three sessions, usually at least two months apart, are needed to achieve the patient’s desired result. The exact sequence or combination depends on many factors, mostly dictated by what bothers the patient the most.
Surgery after Weight Loss: Before and After Photos
Surgery After Weight Loss - Breast Lift & Tummy Tuck
Prior to a gastric sleeve, this 43 year old weighed 250 pounds. Immediately prior to her surgery, she was 5'6" and weighed 160 pounds. She had had three children.+ See Full Case
Breast Reduction with Lift and Abdominoplasty
This 41 year old was interested in surgery after weight loss. She was 5'5" and weighed 170 pounds, down from a high of 235.+ See Full Case
Surgery After Weight Loss - Breast Lift & Tummy Tuck
This 55 year old was 5'6" and weighed 131 pounds following a gastric sleeve, which had reduced her weight from 237 pounds. She had previously had three children.+ See Full Case
The weight loss industry, which offers books, equipment, videos, foods, drinks, and surgery, brought in almost $60 billion just in 2014.
Whether through a combination of diet and exercise, or by undergoing a lap band or gastric bypass procedure, many people use weight loss products and procedures to help them work toward their weight loss goals.
As you might expect, people who have lost a dramatic amount of weight are justifiably thrilled to see those pounds drop off. They may be eager to show off the end result of their hard work to friends and family. However, they may not realize that, while they have lost weight, their skin may not have properly conformed to the new contours of the body. In such cases, patients come to see Dr. Paul Pin to learn more about body contouring procedures that can remove excess skin and tissue following dramatic weight loss.
Skin Elasticity and Weight Loss
Human skin is very elastic. In other words, it has a certain amount of give and can return to its original shape if it is stretched. Unfortunately, there will be a point past which the skin will lose elasticity and not “bounce back.” In the case of dramatic weight loss, the end result is excess loose skin and tissue that hangs in folds. While the weight may have been reduced, that does not necessarily mean that the skin and tissue has also been reduced. For these patients, body contouring procedures may be an option.
Below are some before and after photos that show some of the more common body contouring procedures that can be done. These procedures can be done alone or combined.
Body Contouring Procedures: Before and Afters
Arm Lift: The Before photo clearly shows the excess skin and tissue hanging from the armpit to the elbow. This patient underwent an arm lift procedure, in which Dr. Pin made an incision down the length of her upper arm, lifted up the skin and tissue, and then removed the excess. As can be seen in the After image, the arm now looks more trim and contoured than in the Before picture.
Circumferential Abdominoplasty: The patient in this case lost more than 200 pounds following a gastric bypass surgery. As the Before image shows, there was still a great amount of excess skin and tissue, along with loose abdominal muscles, even after the weight loss. Dr. Pin performed a circumferential abdominoplasty, in which an incision is made all the way around the body at hip level. Excess skin and tissue are removed, and loose abdominal muscles are tightened. The dramatic difference in terms of body contour is more than evident in the After image.
Breast Lift and Reduction: When women lose a large amount of weight, one of the first places where it may show is in the breasts. If the breasts were originally very large, they may sag or droop once they lose weight. This patient underwent both a breast lift (to place the breasts higher on the chest) and a reduction. For this, Dr. Pin first makes an incision around the areola (the darkened skin around the nipple), and then a second incision from the underside of the breast down to the inframammary crease (the point at which the underside of the breast meets the chest wall). Finally, a third incision is made along the inframammary crease.
Breast Lift and Abdominoplasty: This 52 year old was 5’6” and went from 350 pounds to 170 after her gastric bypass. To remove her excess skin, she underwent a breast lift/reduction and an abdominoplasty in one operation.
Post-bariatric Plastic Surgery Outcome and Risks
Surgery to remove excess skin can yield dramatic and gratifying results. Shape can be improved, clothes can fit, and activities can be unimpeded; the formerly obese patient can feel more like a normal person. However, no one should pursue these options without understanding the consequences and potential complications of the above-mentioned plastic surgical procedures.
The most obvious consequence of surgery is scarring. Scars may be good or they may be bad, but when skin is excised the long incisions always heal with some type of scar. These scars are usually well-tolerated, but it should be clear before proceeding where these incisions will be and what they could look like. Numbness is a common and sometimes disturbing consequence that can be prolonged and even permanent in the areas where the surgery is performed.
Complications of extensive procedures like those discussed above are numerous and varied, some minor, and others potentially lethal. As with any surgery, there is always the risk of bleeding and infection.
Bleeding that requires transfusion or more surgery is uncommon, occurring much less than 5 percent of the time. Minor infections are much more common, in the range of 5 to 10 percent, but can usually be treated with oral antibiotics. Significant infections requiring hospitalization and intravenous antibiotics are much less common but do appear to be more frequent in patients who are still considerably overweight at the time of their surgery.
Delayed healing is probably the most common complication noted in these types of plastic surgery procedures. Delayed healing can be due to skin tension following skin removal or diminished skin quality as when stretch marks are prevalent. Smoking dramatically increases the risk of delayed healing and should be completely discontinued prior to surgery. Most such problems are small and can be handled with dressings, though occasionally additional surgery is necessary.
Rarely, surgery such as this can be complicated by deep venous thrombosis, which can lead to blood clots in the patient’s lungs, a condition that can be lethal. Most plastic surgeons utilize special equipment and procedures to minimize this risk. Like infection, this type of risk is more common in the obese patient.
Insurance Coverage for Plastic Surgery after Weight Loss
While surgery to induce weight loss is frequently a benefit of most insurance plans, coverage for procedures to deal with the consequences of the ensuing excess skin is much less common. A limited abdominoplasty or panniculectomy is a common exception, if the insurance company can be convinced that the excess abdominal skin is causing significant medical problems that cannot be managed without surgery.
Dallas Skin Tightening Surgery Consults
Overall, surgery for morbid obesity means thousands can look forward to longer and healthier lives. In carefully selected cases, plastic surgery can help these patients enjoy their weight loss by relieving them of some of their unwanted skin. Contact our Dallas office to learn more about skin tightening plastic surgery procedures that can be performed after weight loss.